Creating health for all

1. Creating health for all Julie Willems Van Dijk RN PhD Associate Scientist/Deputy Director County Health Roadmaps June 12, 2013

2. acknowledgements • Robert Wood Johnson Foundation • Including Abbey Cofsky, Paul Kuehnert, Michelle Larkin, Jim Marks, Joe Marx, Naima Wong • Wisconsin County Health Rankings & Roadmaps Team • Including Bridget Catlin, Patrick Remington, David Kindig, Angela Russell, Amanda Jovaag, Alison Bergum, Kate Konkle, Karen Odegaard, Jan O’Neill • Our Partners • Including Burness Communications, Community Catalyst, United Way Worldwide, ASTHO, NACCHO, NNPHI, Dartmouth Institute, CDC, NCHS

3. Goals • Explore concepts of health disparities, health equity and multiple determinants of health • Identify strategies for creating health for all in your community • Discussion

4. Health disparities • “Health disparities refer to differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death.” (NIH, 2013) • The term health disparities refers to population-specific differences in the presence of disease, health outcomes, quality of health care and access to health care services that exist across racial and ethnic groups. (NCSL, 2013)

5. Healthy people 2020 will track disparities • Race and ethnicity • Gender • Sexual identity and orientation • Disability status or special health care needs • Geographic location (rural and urban)

6. Health equity • Differences in population health status and mortality rates that are systemic, patterned, unfair, unjust, and actionable. (Margaret Whitehead) • Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. (Healthy People 2020)

8. WHY is jason in the hospital? http://www.youtube.com/watch?v=EI_Z-N1qeeo

9. Evans & Stoddart Multiple Determinants of Health, 1994

10. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm, 1991

11. RWJF Commission to Build a Healthier America. Overcoming Obstacles to Health, 2008

14. FRAMEWORK FOR UNDERSTANDING HEALTH INEQUITIES BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE UPSTREAM iNDIVIDUALHEALTHKNOWLEDGE GENETICS DOWNSTREAM Social Factors Health Status SOCIAL INEQUALITIES Class Race/ethnicity Gender Immigration Statuss INSTITUTIONAL POWER Corporations & other businesses Gov't agencies Schools NEIGHBORHOOD CONDITIONS Physical environment Land use Transportation Housing Residential segregation Social environment Experience of class Experience of racism Experience of gender Cultural assimilation /isolation Population histories RISK FACTORS Smoking Nutrition Physical activity Alcohol & other drugs Violence DISEASE & INJURY Infectious disease Chronic disease Injury (intentional & unintentional) MORTALITY Infant mortality Life expectancy HEALTHCARE HEALTH EDUCATION

15. Do we know how much each of the major determinants contributes to health? • Historical perspective • Literature review • Analysis of ability to predict health outcomes

16. Historical Perspective • 1930-1950: Sanitary revolution and improvements in environmental health • 1950-1970: Increasing role of health care • 1970-1990: Contribution of health behaviors(smoking/diet/exercise) increases • 1990-present: Social and economic determinants

17. Review of the Literature

18. Review of the Literature • The oft cited McGinnis et al (2002) paper states: "...using the best available estimates, the impacts of various domains on early deaths in the US distribute roughly as follows: • genetic predispositions, about 30%; • social circumstances, 15%; • environmental exposures, 5%; • behavioral patterns, 40%; and • shortfalls in medical care, 10%.”

19. Analytic Approach

20. Speaking to our partners • Avoid jargon—such as social determinants • Connect with messages they believe in • One fact—not dozens • Offer solutions • Incorporate the role of personal responsibility • Mix conservative & progressive values • Focus on improving health for all (From A New Way to Talk About the Social Determinants of Health, Robert Wood Johnson Foundation, 2010)http://www.rwjf.org/vulnerablepopulations/product.jsp?id=66428

22. Work together Tobacco use Diet & exercise HEALTH BEHAVIORS • Labor unions • Neighborhood organizations • Economic development • Community members • Wellness coordinators • Bar owners/tenders • Healthcare providers • Community members • Business owners • Educators • Advocacy groups • Policymakers • United Way • Law enforcement • Addiction specialists • Educators • Advocacy groups • Policymakers • Faith leaders Alcohol use Sexual activity Access to care CLINICAL CARE • Community members • Foresters • Community members • Advocacy groups • Planning/zoning • Transportation • Healthcare providers • Ombudsmen Quality of care Education Employment SOCIAL & ECONOMIC FACTORS Income Family & social support Community safety Environmental quality PHYSICAL ENVIRONMENT Built environment

23. Assess and focus • Look at data from ALL determinant areas • Disaggregate data by race, ethnicity, income, education, gender, geography • Treat all determinant areas as actionable • CHIPs MUST look beyond health behaviors and access to care to include priorities from the social and economic factors that influence health

24. Results from analysis of WI’s Cha’s/Chip’s Room for Improvement • 20% had sought feedback from the community about the CHA/CHIP and incorporated that feedback into the plan • 14% of 458 priorities were focused on social or economic factors Positive Findings • 85% contained data from all four health factor areas • 85% discussed special populations • 78% had some disaggregated data (most commonly disaggregated by age or gender) • 85% had conducted some type of primary data collection

25. Choose effective policies www.countyhealthrankings.org/roadmaps/what-works-for-health

26. Spectrum of Prevention www.preventioninstitute.org

27. http://www.cdc.gov/about/grand-rounds/archives/2010/download/GR-021810.pdfhttp://www.cdc.gov/about/grand-rounds/archives/2010/download/GR-021810.pdf

28. National Prevention Strategy

29. National Prevention Strategy (p. 23)

30. Social Ecological Model (McElroy, Bibeau, Steckler, & Glanz, 1988)

31. Social Ecological Model In Practice

32. Social Ecological Model(s) Left Version: McElroy et al, 1988; Right Version: Linda Rae Murray, 2010

33. Roadmaps to health prize • Annual prize • Honoring outstanding community efforts and partnerships • Winning communities receive a $25,000 cash prize

34. themes • Care about making a difference • Lead in a way that brings and keeps people together • Partnership means relationship • Meaningful engagement of the community • Focus first and resources will come • The whole is greater than the parts

35. New orleans

36. questions

37. e-Newsletter: chr@match.wisc.edu Staying Connected

38. Thank you Julie Willems Van Dijk RN PhD Deputy Director, County Health Roadmaps University of Wisconsin Population Health Institute 608-263-6731 willemsvandi@wisc.edu